Anatomy Atlas and Interpretation of Spine Surgery

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List of Editors and ContributorsxviiYuan Wang, Ph.D. Second Department of Spine Surgery, Changzheng Hospital, SecondMilitary Medical University, Shanghai, ChinaYing-jie Wang, Ph.D. Second Department of Spine Surgery, Changzheng Hospital, SecondMilitary Medical University, Shanghai, ChinaDe-sheng Wu, Ph.D. Department of Spine Surgery, Shanghai Dongfang Hospital, TheAffiliated Hospital of Tongji University, Shanghai, ChinaHong Xia, Ph.D. General Hospital of Guangzhou Military Command of PLA, Guanghzou,ChinaJian-ru Xiao, Ph.D. Changzheng Hospital, Second Military Medical University, Shanghai,ChinaYi Xiao, Ph.D. Department of Radiology, Changzheng Hospital, Second Military MedicalUniversity, Shanghai, ChinaGuo-hua Xu, Ph.D. Second Department of Spine Surgery, Changzheng Hospital, SecondMilitary Medical University, Shanghai, ChinaPeng Xu, Ph.D. Second Department of Spine Surgery, Changzheng Hospital, Second MilitaryMedical University, Shanghai, ChinaXi-ming Xu, Ph.D. Second Department of Spine Surgery, Changzheng Hospital, SecondMilitary Medical University, Shanghai, ChinaTao Xu, Ph.D. The 113th Hospital of Chinese PLA, Ningbo, ChinaHui-lin Yang, Ph.D. Department of Orthopaedics, The First Affiliated Hospital of SoochowUniversity, Suzhou, ChinaLi-li Yang, Ph.D. Third Department of Spine Surgery, Changzheng Hospital, Second MilitaryMedical University, Shanghai, ChinaHai-song Yang, Ph.D. Second Department of Spine Surgery, Changzheng Hospital, SecondMilitary Medical University, Shanghai, ChinaXing-hai Yang, Ph.D. Department of Orthopaedic Tumor, Changzheng Hospital, SecondMilitary Medical University, Shanghai, ChinaXiao-jian Ye, Ph.D. Changzheng Hospital, Second Military Medical University, Shanghai,ChinaBin-sheng Yu, Ph.D. Department of Orthopaedics, Peking University Shenzhen Hospital,Shenzhen, ChinaHong-bin Yuan, Ph.D. Department of Anesthesiology, Changzheng Hospital, SecondMilitary Medical University, Shanghai, ChinaXue-song Zhang, Ph.D. Department of Spine Surgery, Chinese PLA General Hospital,Beijing, ChinaJie Zhao, Ph.D. Department of Orthopaedics, Shanghai Ninth People’s Hospital, ShanghaiJiaoTong University School of Medicine, Shanghai, ChinaZhao-min Zheng, Ph.D. Department of Spine Surgery, The First Affiliated Hospital, SunYat-sen University, Guangzhou, ChinaXu-hui Zhou, Ph.D. Fourth Department of Spine Surgery, Changzheng Hospital, SecondMilitary Medical University, Shanghai, ChinaZe-zhang Zhu, Ph.D. Department of Orthopaedics, Nanjing Drum Tower Hospital, TheAffiliated Hospital of Nanjing University Medical School, Nanjing, China
Surgical Anatomy of UpperCervical Spine1Jian-gang Shi, Wen Yuan, and Jing-chuan Sun1 Atlantoaxial Exposure bythe Transoral–TranspharyngealApproach1.1 OverviewFirst reported by Kanavel in 1917, the transoral–transpharyngealapproach is the most direct surgical approach to theanterior occipitocervical area. This approach can preferablyexpose the anterior atlantoaxial structure and is often usedfor the resection of the anterior arch of the atlas and treatmentof odontoid process base invagination, infection, tumor,and irreducible odontoid fractures during chronic dislocation.It is also used in the management of congenital malformationin the anterior atlantoaxial region. Since this surgicalapproach is limited by the mandible and oral cavity, its fieldof vision is relatively narrow. Its exposure generally rangesfrom the basilar clivus to the upper part of C3, but can beexpanded toward the head by incising the soft and hardpalates. The range of mandibular joint motion should beevaluated prior to surgery by physical examination andX-ray. For patients who have difficulty in opening theirmouths, other surgical approaches should be considered. Theadvantage of the anterior approach is the absence of majorvessels and nerves, and the most common complications areinfection and cerebrospinal fluid leakage.1.2 PositionThe patient is placed in supine position. Shoulders aresupported by soft pillows, and the neck is cushionedwith a neck pillow in order to mildly extend the cervicalspine (Fig. 1.1).Insert the retractor systems to keep the mouth openand retract the tubes out of view (Figs. 1.2 and 1.3).Fig. 1.1 Atlantoaxial exposure by the transoral–transpharyngeal approachtonguePosterior Palatinepharyngeal wall uvulacephaladJ.-g. Shi (*) • W. Yuan • J.-c. SunDepartment of Orthopedics, Changzheng Hospital,Shanghai, Chinae-mail: shijiangang616@163.com; yuanwenspine@163.com;sjchxc@foxmail.comFig. 1.2 Insertion of automatic retractor into the oropharynx to exposethe posterior pharyngeal wall© Springer Nature Singapore Pte Ltd. and Shanghai Scientific and Technical Publishers 2018J.-g. Shi et al. (eds.), Anatomy Atlas and Interpretation of Spine Surgery, https://doi.org/10.1007/978-981-10-5906-3_11
Page 1 and 2: Anatomy Atlasand Interpretationof S
Page 3 and 4: Jian-gang Shi • Wen Yuan • Jing
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1 Surgical Anatomy of Upper Cervica
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1 Surgical Anatomy of Upper Cervica
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Surgical Anatomy of the SubaxialCer
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2 Surgical Anatomy of the Subaxial
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Surgical Anatomy of the Thoracic Sp
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3 Surgical Anatomy of the Thoracic
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Surgical Anatomy of the Lumbar Spin
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4 Surgical Anatomy of the Lumbar Sp
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2841.3 ExposureMake a midline incis
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286J.-g. Shi et al.Fig. 5.8 Intraop
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288J.-g. Shi et al.Fig. 5.12 Antero
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290J.-g. Shi et al.Femoral nerve: t
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292J.-g. Shi et al.Fig. 5.19 Nerves
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